So this is actually a picture we couldn't take any time in the last 50 years. A surgeon surrounded by residents about to do an operation. And if you had never seen incision, this is designed to make you remember this talk. But the implants pretty much haven't changed, and actually may not. But what is fundamentally different, this is where I disagree with everybody who kind of says that nothing's changed since 1800, is that this is a patient of mine who I'd finished operating. This is 3:00 PM. She came out the operating room at 10:00 AM, she then goes home, drives for three hours to Sacramento, and then writes me an email saying how wonderful she's doing. And then she is cared for on a digital platform. This is HealthLoop. You've probably seen it on Ranger before. You'll email her everyday asking her questions. The answers to those questions trigger answers to me and to my team, and then we can send an asynchronous video through CaptureProof, another digital platform that enabled us to give them physical therapy at home where they want, when they want it. And by the way, we looked at this, and the outcomes are equal to traditional physical therapy. So I know everything has changed. A lot has changed; even as we integrate standard care.
Now how about the education piece? Well, this moves along quite a bit, too. We'd have to wait for the future. The future is here. Instead of dissecting a real cadaver, we can now dissect a virtual cadaver and reassemble them and dissect them and reassemble them sequentially to educate our students.
What about the virtual reality as it's applied to education of anatomy? This work that's been done with Microsoft and the Holo system is really remarkable. You can imagine what an experience our students are going to have as they can interact and interface with the body and anatomy at the click of an air finger. This hasn't really hit us yet, but hologram technology-- which is really getting quite interesting in the gaming world-- imagine what we can do with that.
What if we take the hologram of Daniel Kraft to bring a special medicine to a classroom? What if I bring a patient to the classroom? What if I bring the doctor to the patient's house? And simply by having everybody wired or video cameras everywhere, an interface can happen which couldn't have happened before. It looks like Star Trek.
But I challenge a question, is this really exponential? Is this a paradigm shift? Is it changing things as badly as Nicholas did back in his day when he suggested that maybe the sun does not really revolve around the Earth? This is the digitization of analog projects. This is the digitization of the Yellow Cab; but it's not Uber. It's not disruptive. It's not a phone without a keyboard as we heard so frequently said. So the question then becomes, if we want to think about the future, which this conference is really all about, what is the technologist going to bring us there? What is going to be the disrupting technology?
So let's go through a couple of them that have been suggested. One is augmented reality. Augmented reality simply brings me-- or more data to me at the same time as I'm operating as a surgeon. I'm essentially multiple places at the same time. And I'll be able to use that data feed to help me educate my thinking as I move forward.
What about interactive virtual reality? Now Justin just showed you this. I didn't know he was coming before me. There's no point in redoing it. I'll go through it, but essentially the idea that now with this virtual reality context, I am actually interfacing with it. So we know the learning happens by doing, and when you're actually mechanically working through the process, it's a lot more effective to your learning than reading about it or seeing it.
Robotics. For those who went outside and played with these machines, this is pretty phenomenal. Allows us to operate remotely. Remotely could be six feet; it could also be 6,000 miles. So that could change things a lot. Tissue regeneration is pretty phenomenal. This is little rabbit had his shoulder operated on. They opened it up, they took out half of his shoulder, put it into a scanner, scanned it, printed a bioscaffold, put it back in the body infused the TGF data. Came back after weeks. Of course, he's walking normally. But when you look at the histology, it looked almost normal.
So that opens up a whole new idea. Can we possibly re-engineer, reprint whole new tissue parts? Now think about that. That would really change the way we think about surgery, right? Hey, you got a blocked artery, we'll just print you a new one and stick it in. This company is thinking even bigger than that. What about the future? What if a passing flying car, a UFO, takes out a third of your tibia. You got a big huge gap. This nice robot will take you into the clinic. They'll scan the other side, make sure to make a biocompatible print or image of the other side so it's perfect, and then they'll print a mirror image of it directly over your tibia, seal it with new skin, all done. Maybe a little splint and off you go. Wow. Pretty innovative thinking.
How about the internet of things? Is that going to be the fundamental change or agent in health care? We have all this data, embedded chips, sensors, communication devices in everything, what about putting them in the sensors in devices that are in us? You remember that implant I showed you earlier? There's a lot of people talking today about smart devices that actually feedback information to us and to our physicians or clinicians about how implants in our body are doing so we can fix them before they fail. Interesting idea.
You take all that data, you plug it into an artificial intelligence network, and then suddenly you can realize very quickly diagnostics come out of the picture for physicians. The computers are going to be much more accurate than we are. So what does that do to education? Well, surgical specialty trainings potentially could change vastly. The amount of time it takes us to train a resident is directly related to how often they do the operation.
Let's just say my hospital-- we don't have too many tibia fractures like Justin showed you. And he has to wait six or eight months to do three or four of them; not nearly as efficient as doing it seven or eight times in a virtual environment. So we can probably short circuit significantly the training of residents in many areas.
But there's other things we have to add to the medical curriculum. If algorithm data sets are going to be driving our decision-making, we better understand what those datasets and algorithms can deliver. And we don't teach higher resolution math in the medical schools today. Publishing research and writing is going to have to change drastically. I'm sorry for all of us who really love randomized controlled trials, but by the time we get the answer in a not-too-distant future, the question will be irrelevant, not the answer.
We have to learn how to appreciate or embrace associative datasets. Now, the other thing we teach our residents is computer science. Because if things break in the current day, it's an instrument. I can use another one. I can sew it up. I can do something to it. But if it's a software application, I'd better know how to hack into it and how to rewrite the code and how to manage it so that I can get to the outcomes that I want in real time. And I think we have to teach medical students how to have screenside manner as opposed to bedside manner. It's going to become a bigger part of how we treat patients.
But is that Copernican in its impact? I don't know. It's still the patient collecting data. That data has been processed in more fabulous ways. It's coming to a physician who's going to then use some new fabulous techniques to provide care. It's the same model. It's not disruptive. Disruption happens when the model changes. When we fundamentally rethink what's going to happen. And the MD here is basically Yellow Cab.
So here's a bit of a difficult statement to make. Maybe this is what has to change. The patient-physician relationship, which is at the center of every pathway in health-care delivery, and it may not be a physician but it's a care provider, actually turns out to be the bottleneck that will prevent us from moving forward. But is that really the case?
So Glimpse, a company that came out a year ago and was very quickly bought by Apple because they solve a very difficult problem, which is to enable patients to get their entire medical record wherever they'd received care, wherever they got drugs-- Walgreens, Kaiser, or wherever, pulling them into a single dataset that actually became a single unified data point. That changes everything because that democratizes the data. It puts the data in the hands of the patient and no longer a second or third entity.
And if that happens and the patient chooses to put in an electronic medical record of another health care system, fine. That's something we've already conceived of. But what if you take that data, put it into an app or a couple of apps? And you know, today, a lot of what we do as physicians isn't that complicated. It's not life threatening. It's a cold. It could be a child's runny nose. And we don't necessarily have to have a clinician or physician figure that out. And it's now the patient's right and choice to be able to put that information into a different care module.
But let's take that one step further. They can get information from the internet. They can get it from Twitter. They can get it from an entire network that everybody here is participating in building, which is ready and willing to support that patient in their decision-making process.
United. Why am I showing it here? Because this democratization of data has lots of other fascinating implications down the road. Now if the patient is able to participate in their care management, why can't they participate in how we deliver care? So United Airlines and a bunch of airlines had a lot of problems. Petroleum was $100 a barrel, and when we had a couple of buildings go down and travel dropped significantly, what they found was that in order to stay viable, they reached out to their customers to become their employees.
So how many any of you ever printed your own boarding pass? How many of you have ever just gone online and booked your own flight? This is all stuff that was happening by employees of the airlines in the past. They're able to trade you what? Convenience for the work that they use to formally do. Why don't we do that in health care? Patients are ready, willing, and able to participate in the health care delivery model.
What about research? So one of the great stories that occasionally gets told is this idea that patients sometimes-- especially for rare diseases-- are more educated than some of the professors in the universities. What's that look like? Niemann-Pick disease is a disease that's very rare, autosomal, and most children die about age six or eight. Eight parents saw a research paper that had been published and that this drug that is a byproduct of the production of another drug could actually cure the disease. Got together, created an interest group, and basically forced or worked with the FDA to get it approved relatively quickly and actually became a product that's available. That wouldn't have happened 20 years ago.
So where does that leave us as physicians? So just say, well, maybe we may be destroying or breaking down or manipulating the patient-physician relationship which we hold so dear and which is so valuable to us and to our patients. But in reality, the physician as coach is a very interesting model because we're no longer at the center of that interface. We're no longer in the middle between the patient and the outcome. We're now at the periphery with the patient in the center; and this can be Copernican. Because look at this-- it changes everything.
Because now let's talk about education. Before I'd be teaching these younger MDs to help in this pathway; but now, you can teach the family to help. The friends network. But the payer has an interest in the patient being educated and treated, the hospitals has an interest in that, everyone around in the circle has an interest in supporting that person in the middle to achieve the best possible care. And that model, which is essentially the outcome of democratization of any dataset ever in the history of mankind, has the potential to completely bend the cost curve and change it fundamentally. So that's why I think that the combination of changing that social contract, the social values around that relationship, and the enabling technologies that still allows us to deliver great care to the patient despite its absence is going to be what changes everything, not the digitization of what is still an analog pathway.
So these are the students that are in Geneva. Adrian and Savannah. Now Savannah's the one that wrote you a poem I'm about to read to you. But the reason they're up there is because they're at Burning Man. And this is a place where people's minds are encouraged to think out of the box. And you've got an entire generation of people who are not hindered from the past and can think aloud and very, very openly about what the future can bring to them. And this is how they see it. And this is from Savannah, if you don't mind me reading this. They'll send us some pictures of what we've being up to.
"As the waves lapped the beach, narrowly missing our fragile castle, the pillars of sand rocked to the rhythm of feet. Falling in an audible beat. Things were changing. Knees were bouncing. Hips were swinging. And people were listening to the construction of the future." And that's who we're building it for. It's not going to happen quickly. Social things take a while, but it's going to be the fundamental enabler of the change we're all looking for; that massive redistribution of care. The idea that we're going to go from a digitization of an analog process to an entirely visually native solution.
It won't be a specific technology that does it. The technologies enable it. But it's going to be a change in the way we think about the patient-physician relationship, I would argue, that is at the core of that change. So I'll leave it with this. It's another picture from Burning Man. This is a humongous frame. It's empty. You can do with it what you want. It is sort of where we are. There's really nothing behind it, or what's behind it now is probably not going to be there in five years.
So I would argue that the slow but inexorable change in social values coupled to enabling technologies, will disintermediate the patient-physician relationship? And allow the creation of a completely new digital care delivery system that'll be unfettered by the analog framework of our past. So for those of you developing apps, they're like products. Think about reaching not just the physician, not just the resident, but everybody that's going to be orbiting around the patients that seek care. Thank you very much.
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